Japanese
Title心音II音同期・心電図R波逆同期RI心プールイメージング法による冠動脈疾患の左室拡張期充満動態の解析 - 拡張早期充満異常と左房収縮の役割 -
Subtitle原著
Authors石田良雄*
Authors(kana)
Organization*大阪大学医学部第一内科
Journal核医学
Volume21
Number7
Page831-843
Year/Month1984/7
Article原著
Publisher日本核医学会
Abstract「要旨」冠動脈疾患の左室拡張期充満動態を心音II音同期・心電図R波逆同期法を採用したマルチトリガRI心プールイメージング法を開発することにより解析した. 冠動脈疾患のうち, 心筋梗塞を伴わない群(CAD-1群:19例)では, 正常群(N群:15例)に比し, 駆出率(EF), 最大駆出速度(PER)に有意差を認めなかったが, 急速流入期最大充満速度(PFR-RF)は, 1.8±0.4 EDV/sec, 充満率(FF)は30.8±7.8%とそれぞれN群の2.6±0.6EDV/sec, 35.3±7.5%に比し有意な低下を認めた. また, 心房収縮期最大充満速度(PFR-AC)は, 1.2±0.5 ECV/sec, 心房収縮期充満量の一回拍出量に対する比(AC/SV)は27.2±8.1%でそれぞれ, N群の0.9±0.4 EDV/sec, 15.5±7.5%に比し有意に高値を示した. 一方, 心筋梗塞を合併した群(CAD-2群:25例)では, PFR-RF, FFはそれぞれ, 1.5±0.5 EDV/sec, 22.5±11.5%とCAD-1群よりもさらに低値を示したが, PFR-ACは0.8±0.5 EDV/secでN群と有意差がなく, AC/SVは一定の傾向が認められなかった. 以上の結果は, 1)冠動脈疾患では拡張期動態の異常が収縮期動態の異常より早期に認められること, 2)心筋梗塞を伴わない例では拡張早期充満の減少に対し, 心房収縮による充満の代償的増大が認められること, 3)心筋梗塞を伴う例ではこの心房収縮による代償が制限を受けることを示唆する.
Practice臨床医学：一般
KeywordsMulti-triggered radionuclide ventriculography, Coronary artery disease, Impairment of early diastolic filling, Atrial contribution.
English
TitleAnalysis of Left Ventricular Filling in Patients with Coronary Artery Disease by a New Radionuclide Ventriculographic Method Using Second Heart Sound, and Forward and Backward ECG Gating Techniques - The Impairment of Early Diastolic Filling and the Contribution of Atrial Contraction to Total Filling -
SubtitleOriginal Articles
AuthorsYoshio ISHIDA
Authors(kana)
OrganizationThe First Department of Medicine, Osaka University, Medical School
JournalThe Japanese Journal of nuclear medicine
Volume21
Number7
Page831-843
Year/Month1984/7
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]To investigate the function of left ventricular filling in patients with coronary artery disease (CAD), we developed a new multi-triggered radionuclide ventriculographic method. The data was acquired in a list mode as a series of X, Y coordinates with time markers, ECG R wave (R) markers, and second heart sound (S2) markers. Left ventricular volume (LVV) curves were obtained from three types of multigated images, i. e. (1) R-synchronized forward reformatting for the analysis of systolic phase (ejection fraction (EF) and peak ejection rate (PER)), (2) S2-synchronized forward reformatting for the analysis of rapid filling (RF) phase (peak filling rate (PFR-RF) and filling fraction (FF)) and (3) R-Synchronized backward reformatting for the analysis of atrial contraction (AC) phase (peak filling rate (PFR-AC) and the relative increment of LVV with atrial contraction: AC/Stroke Volume (SV)). Fifteen normals (N) and 44 patients with CAD were studied. The latter patients were subdivided into two groups; 19 patients (CAD-1) without and 25 patients (CAD-2) with a prior myocardial infarction (MI). EF and PER were significantly lower in CAD-2 (EF: 42.8 +- 11.9% and PER: -1.8 +- 0.6 EDV/sec) than in N(EF: 59.1 +- 5.0% and PER: -2.5 +- 0.5 EDV/sec), whereas these parameters in CAD-1 (EF: 56.1 +- 7.2% and PER: -2.4 +- 0.4 EDV/sec) were not significantly different from those in N. However, PFR-RF and FF were markedly lower in both CAD-1 (PFR-RF: 1.8 +- 0.4 EDV/sec and FF: 30.8 +- 7.8%) and CAD-2 (PFR-RF: 1.5 +- 0.5 EDV/sec and FF: 22.5 +- 11.3%) compared with N(PFR-RF: 2.6 +- 0.6 EDV/sec and FF: 35.3 +- 7.5%). PFR-AC and AC/SV were significantly higher in CAD-1 (PFR-AC: 1.2 +- 0.5 EDV/sec and AC/SV 27.2 +- 8.1%) than in N (PFR-AC: 0.9 +- 0.4 EDV/sec and AC/SV: 15.5 +- 7.5%). In CAD-2, PFR-AC and AC/SV (PFR-AC: 0.8 +- 0.5 EDV/sec and AC/SV: 22.3 +- 10.8%) were significantly lower than in CAD-1 and were not statistically different form those in N, although AC/SV was higher than in N. AC/SV tended to increase with decreasing PFR-RF in CAD-1 and N, but such correlation between them was not observed in CAD-2. AC/SV in CAD-2 progressively decreased associated with the enlargement of the infarct size estimated by ΣCPK. In conclusion, the function of early diastloic filling in patients with CAD is impaired and the atrial contribution may play an important role in compensating for the impaired early diastolic filling in CAD patients without a prior MI. However, this comensatory mechanism may be limited in patients with a prior MI; presumably because of the elevated left ventricular diastolic pressure.
PracticeClinical medicine
KeywordsMulti-triggered radionuclide ventriculography, Coronary artery disease, Impairment of early diastolic filling, Atrial contribution.

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